Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors.

Publication ,  Journal Article
Routh, JC; Nelson, CP; Graham, DA; Lieu, TA
Published in: Pediatrics
March 2010

OBJECTIVE: Controversy exists over surgical procedure choice for vesicoureteral reflux (VUR) in children. Either ureteral reimplantation (UR) or a newer procedure, endoscopic injection (EI), may be chosen; however, the factors that determine procedure choice for any individual patient are unclear. The objective of this study was to identify patient and hospital factors associated with the choice of EI for children undergoing antireflux surgery. PATIENTS AND METHODS: We searched the Pediatric Health Information System, a national database collected by freestanding children's hospitals. We identified children aged <18 years with primary VUR who underwent surgery (UR or EI) between 2003 and 2008. We used multivariate logistic regression models to evaluate whether the type of procedure performed was associated with hospital-level factors including individual hospital, hospital region, size, and teaching status, as well as patient features including age, race, gender, and insurance type. RESULTS: We identified 15026 children with primary VUR who underwent antireflux surgery between 2003 and 2008. Of these, 3611 children (24%) were treated at hospitals that performed reimplant only. Among children treated at institutions offering both procedures, 5562 (49%) underwent injection and 5853 (51%) underwent reimplant. Patients who received EI were significantly older and more likely to be girls, white, and publicly insured than those who had UR. They were more likely to have been treated at hospitals that were larger, were teaching hospitals, or were located in larger metropolitan areas or the South rather than the Northeast. After adjusting for other covariates, the treating hospital was the most important factor predicting procedure choice. CONCLUSIONS: The hospital at which a patient receives treatment is the single most important feature that drove procedure choice for children with primary VUR. The patient's age, gender, insurance status, and disease severity played a smaller, although significant, role.

Duke Scholars

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

March 2010

Volume

125

Issue

3

Start / End Page

e446 / e451

Location

United States

Related Subject Headings

  • Vesico-Ureteral Reflux
  • Urologic Surgical Procedures
  • Ureter
  • Retrospective Studies
  • Pediatrics
  • Multivariate Analysis
  • Male
  • Injections
  • Infant
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Routh, J. C., Nelson, C. P., Graham, D. A., & Lieu, T. A. (2010). Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors. Pediatrics, 125(3), e446–e451. https://doi.org/10.1542/peds.2009-1237
Routh, Jonathan C., Caleb P. Nelson, Dionne A. Graham, and Tracy A. Lieu. “Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors.Pediatrics 125, no. 3 (March 2010): e446–51. https://doi.org/10.1542/peds.2009-1237.
Routh JC, Nelson CP, Graham DA, Lieu TA. Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors. Pediatrics. 2010 Mar;125(3):e446–51.
Routh, Jonathan C., et al. “Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors.Pediatrics, vol. 125, no. 3, Mar. 2010, pp. e446–51. Pubmed, doi:10.1542/peds.2009-1237.
Routh JC, Nelson CP, Graham DA, Lieu TA. Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors. Pediatrics. 2010 Mar;125(3):e446–e451.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

March 2010

Volume

125

Issue

3

Start / End Page

e446 / e451

Location

United States

Related Subject Headings

  • Vesico-Ureteral Reflux
  • Urologic Surgical Procedures
  • Ureter
  • Retrospective Studies
  • Pediatrics
  • Multivariate Analysis
  • Male
  • Injections
  • Infant
  • Humans